BILL ANALYSIS                                                                                                                                                                                                    Ó




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair

                                          SB 161 (Huff)
          
          Hearing Date: 05/26/2011        Amended: 05/17/2011
          Consultant: Jacqueline Wong-HernandezPolicy Vote: Education 6-1, 
          Health 7-0
          _________________________________________________________________
          ____
          BILL SUMMARY: SB 161 would authorize a school district to 
          provide school employees with voluntary emergency medical 
          training to provide, in the absence of a nurse, to provide 
          emergency medical assistance to pupils with epilepsy suffering 
          from seizures, according to specified guidelines. This bill 
          would allow the parent/guardian of a pupil who has been 
          prescribed an emergency antiseizure medication, as defined, to 
          request the pupil's school have one or more employees receive 
          voluntary training to administer the medication. This bill 
          outlines notification and training procedures for school 
          districts and employees that elect to provide this training and 
          authority. This bill encourages the Epilepsy Foundation of 
          America to develop guidelines for the training and supervision 
          of school employees in providing emergency medical assistance, 
          as specified, and authorizes the California Department of 
          Education (CDE) to include on its website a clearinghouse of 
          best practices for training nonmedical personnel to administer 
          emergency antiseizure medication. This bill makes legislative 
          findings and declarations. 
          _________________________________________________________________
          ____
                            Fiscal Impact (in thousands)

           Major Provisions          2011-12      2012-13       2013-14      Fund
           
          DPH guidelines                           Potentially significant 
          one-time costs            General                         

          CDE consultation                              Likely minor 
          one-time costs                    General  
                                                                      
          CDE website information                     --- Minor and 
          absorbable ---                  General
          _________________________________________________________________
          ____









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          STAFF COMMENTS: SUSPENSE FILE. 
          
          Under existing law, the Nursing Practice Act sets forth the 
          scope of practice for nursing, which specifically includes the 
          administration of medication, and prohibits any person from 
          engaging in the practice of nursing without a license.  Current 
          law authorizes non-medical school personnel to administer 
          certain medications (epinephrine auto-injectors, glucagon) to a 
          pupil in an emergency, as specified.  Current law allows 
          non-medical school personnel to assist or administer medication 
          to a pupil on a routine basis in certain cases, regarding 
          epinephrine, inhaled asthma medication, or in cases where the 
          pupil's health care provider gives a written statement with 
          specific information, such as the medication the pupil is to 
          take, the dosage, and the period of time during which the 
          medication is to be taken, and if the pupil's parent provides a 
          written statement initiating a request to have the medication 
          administered to the pupil or to have the pupil otherwise 
          assisted in the administration of the medication.  

          This bill would authorize a school district to provide school 
          employees with voluntary training for the provision of emergency 
          medical assistance to certain pupils suffering from an epileptic 
          seizure, in accordance with "a training plan approved on the 
          department's Internet Web site" and to "the performance 
          instructions set forth by the licensed health care provider of 
          the pupil."  The bill provides that the parent of a pupil that 
          is prescribed emergency antiseizure medication may request the 
          school to have one or more employees trained to administer the 
          drug when a nurse is not available. Upon receipt of the request, 
          the school would be required to notify the parent that the pupil 
          may qualify for a Section 504 plan (under the federal 
          Rehabilitation Act of 1973) and can be assessed at the parent's 
          request. 

          If the parent does not choose to have the pupil assessed for a 
          504 plan, the school may opt to create an individualized health 
          plan to prepare to meet the pupil's needs.  If the school 
          district had chosen to allow participation, a school under its 
          jurisdiction may solicit volunteers to be trained to administer 
          emergency antiseizure medication in the absence of licensed 
          professional, as specified.  If there are no volunteers, the 
          school would re-notify the parent of the option to be assessed 
          for a 504 plan, pursuant to federal law. 








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          The school plan would include the identification of existing 
          licensed personnel that could be trained to administer the 
          medication, identification of pupils who may require the 
          administration, written authorization from the parent that 
          nonmedical personnel may administer the emergency antiseizure 
          medication to the pupil, and a written statement from the 
          pupil's health care practitioner specifying the proper dosage, 
          appropriate time for administration, and other specified 
          protocols. While this bill specifically provides for school 
          districts to decide whether or not to provide this training (and 
          thus, participate), it is unclear whether a school 
          administrator, upon receiving a request, could decide whether 
          his or her school would participate in seeking and providing 
          specified volunteers.  

          This bill specifies that an individual who has volunteered to 
          administer emergency antiseizure medication may rescind his or 
          her offer to do so with a two-week notice, as specified. It is 
          unclear what the consequences of violating this provision would 
          be. If a volunteer were, for example, to decide to that he or 
          she did not feel comfortable administering the medication in a 
          moment of necessity, it is unclear what would happen. 
          Participating schools would be required to provide 
          indemnification and legal defense for volunteers for actions 
          they volunteered to take on, but it is unclear whether that 
          would be provided if a volunteer decides not to perform 
          activities for which he or she was trained and which were part 
          of a pupil's seizure plan at the school.

          Any costs incurred by the district for the training of personnel 
          and administration of the drug would be at local discretion or 
          pursuant to Section 504, so there should be no increase in state 
          costs for those activities. To the extent that a voluntary 
          process is successfully implemented as an alternative to a 
          likely more expensive Section 504 accommodation, there may be 
          significant local savings for schools with pupils who have been 
          prescribed emergency antiseizure medication.

          This bill encourages the Epilepsy Foundation of America 
          (Epilepsy Foundation) to develop guidelines for the training and 
          supervision of school employees in providing emergency medical 
          assistance to pupils with epilepsy suffering from seizures, and 
          provides that the guidelines may be developed in cooperation 








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          with the State Department of Education, the California School 
          Nurses Organization, the California Medical Association, and the 
          American Academy of Pediatrics. Upon development of the 
          guidelines, the CDE is authorized to review and approve them for 
          distribution and to make those guidelines available upon 
          request. The CDE is also permitted to post guidelines and a 
          clearinghouse of best practices.

          This bill specifically provides that volunteers will follow a 
          training plan posted on the CDE website. Thus, implementation 
          presumes that these permitted activities (involving both the 
          Epilepsy Foundation and the CDE) will occur. As drafted, this 
          bill's implementation could be delayed or stopped by the 
          foundation or CDE's decisions and time tables for completing 
          voluntary activities. CDE participation in developing and 
          approving training guidelines could result in significant costs 
          to the department, depending on its level of participation and 
          the extent of the guideline development process. This process is 
          likely to be complex and potentially contentious, depending on 
          the stakeholders involved.  Requiring CDE participation in order 
          to implement the voluntary provisions of this bill creates cost 
          pressure to the CDE to review and approve guidelines. This would 
          likely involve significant staff time for existing departmental 
          staff, and could require contracting a part-time nurse or other 
          medical professional to advise CDE in its approval process. The 
          CDE has indicated it will submit a Budget Change Proposal 
          requesting an additional position should it determine one is 
          necessary to implement this provision. 

          Staff notes that while litigation costs are not typically 
          considered in this committee, this bill is likely to invite 
          litigation against the CDE if guidelines are approved and posted 
          for administering specified antiseizure medication. Similar 
          scope of practice issues are currently being litigated between 
          the American Nurses Association and the CDE, with regard to 
          administering insulin injections. American Nurses Association v. 
          Jack O'Connell, Superintendent of Public Instruction and 
          American Diabetes Association is before the California Supreme 
          Court, and the CDE expects the case will be decided late this 
          year.  

          As proposed to be amended: Require the Department of Public 
          Health, in consultation with the Department of Education to 
          develop guidelines. Specify restrictions volunteer solicitation.








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